Radiolucent cholesterol gallstones can be dissolved rapidly bymethyl terc-buryl ether MTBE introduced directly into the gallbladder. Percutaneoustranshepatic catheter placement is a well established interventionalradiology procedure and is the preferred route for MTBE administration. A smallnumber of patients have been treated using nasobiliary placement of a gallbladdercatheter. Rapid stirring automatic pump systems allow dissolution of mostcholesterol stones, but some may require extracorporeal shock wave lithotripsyto achieve complete dissolution and aspiration of debris. Large bore percutaneousfragmentation and extraction methods require general anesthesia but are applicableto pigment stones.